Individual
MISTY LOVE CHASTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-7826
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
103816
NC
363AM0700X
Medical Physician Assistant
Primary
2825
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P99126
UPIN
NC
Enumeration date
10/19/2006
Last updated
09/18/2018
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